The previous four chapters described the effects of the neoliberal restructuring of Southville Community Mental Health Team (CMHT) during the first phase of data collection. Between then and the second phase, there were three key areas of policy reform and service transformation. These were: austerityrelated funding constraints within local authorities and the National Health Service (NHS); welfare reform; and the service-line management (SLM) reorganisation of team structures and service delivery within the Trust. This chapter, based on the second phase of data collection, will examine these processes and their effects, in particular how service provision became more short term and the managerial culture more punitive following the transition to a Rehabilitation and Recovery Team (RRT) structure.

The policy context of service transformation

The austerity agenda and funding constraints

In Chapter 1, three phases of neoliberal mental health policy and service delivery reforms were identified, with the most recent – the austerity phase – beginning to emerge from 2009. However, this policy agenda was dramatically escalated and deepened with the election of the Conservative– Liberal coalition government in 2010. Impacts on the health and social care sectors were significant. The NHS was faced with a combination of unprecedented funding constraints amid rising demand. This led to a substantial funding gap, while the social care sector experienced even greater relative spending reductions (Stoye, 2017; Watkins et al, 2017).

In NHS statutory mental health services, during 2011/ 12, the coalition government presided over a cut in funding for the first time in a decade. Most mental health providers continued to face falling income throughout its term (Gilburt, 2016). NHS Mental Health Trusts sought to manage this funding crisis through strategies such as reductions in levels of staffing and inpatient provision (Gilburt, 2015). At the national level there was a 13 per cent fall in the number of full-time-equivalent mental health nurses between 2009 and 2017 – that includes a reduction in the number of more experienced nurses (Gilburt, 2018) – and a 30 per cent cut in the number of inpatient beds between 2009 and 2018 (Helm and Campbell, 2018).